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[目的]分析鼻咽癌患者接受根治性调强放射治疗后出现腮腺淋巴结转移的临床特点及可能的危险因素。[方法]回顾2008~2011年接受调强放射治疗后出现腮腺淋巴结转移的患者,分析原发肿瘤侵犯的结构及淋巴结分布规律。重新勾画腮腺浅叶,分析复发侧的腮腺及浅叶剂量参数。[结果]9例腮腺淋巴结转移患者(中位年龄44岁)均为局部晚期,复发部位主要位于腮腺浅叶(14/16),初诊至转移的中位时间为25个月。转移同侧的颈淋巴结分布情况为:咽后淋巴结(9/9)、Ⅱ区(9/9)、Ⅲ区(4/9)、Ⅳ区(1/9)、Ⅴa区(2/9)、锁骨上区(2/9)。同侧阳性淋巴结77%存在包膜外侵。复发侧腮腺及腮腺浅叶的平均剂量分别为32.2Gy和25Gy。[结论]对于颈部多发淋巴结,尤其是咽后及Ⅱ区巨大淋巴结伴包膜外侵的患者,应提高腮腺区域亚临床病灶的警惕。对高危患者腮腺区的保护是调强放疗后腮腺淋巴结转移的诱因。
[Objective] To analyze the clinical features and possible risk factors of parotid lymph node metastasis in patients with nasopharyngeal carcinoma after radical IMRT. [Methods] The patients with parotid lymph node metastasis who underwent intensity-modulated radiotherapy from 2008 to 2011 were retrospectively analyzed. The structure and distribution of lymph nodes were analyzed. Researched the parotid shin and analyzed the dose parameters of the parotid gland and the shrew. [Results] All the 9 patients with parotid lymph node metastases (median age 44 years) were locally advanced. The recurrence sites were mainly located in the parotid glandular lobes (14/16). The median time from initial diagnosis to transfer was 25 months. The distribution of ipsilateral cervical lymph nodes were: posterior pharyngeal lymph nodes (9/9), Ⅱ (9/9), Ⅲ (4/9), Ⅳ (1/9), Va (2/9) , Supraclavicular area (2/9). 77% of ipsilateral positive lymph nodes have envelope invasion. The average doses of parotid gland and parotid gland in the recurrent side were 32.2 Gy and 25 Gy, respectively. [Conclusion] For the multiple cervical lymph nodes, especially in the posterior pharyngeal area and Ⅱ large lymph nodes associated with extracapsular invasion of patients, parotid gland area should be increased vigilance subclinical lesions. The protection of the parotid gland in high-risk patients is an incentive for metastatic parotid lymph node metastasis after radiotherapy.